Diagnosis and Treatment of Peritalar Injuries in the Acute Trauma Setting: A Review of the Literature

The bony and ligamentous structure of the foot is a complex kinematic interaction, designed to transmit force and motion in an energy-efficient and stable manner. Visible deformity of the foot or atypical patterns of swelling should raise significant concern for foot trauma. In some instances, disruption of either bony structure or supporting ligaments is identified years after injury due to chronic pain in the hindfoot or midfoot. This article will focus on injuries relating to the peritalar complex, the bony articulation between the tibia, talus, calcaneus, and navicular bones, supplemented with multiple ligamentous structures. Attention will be given to the five most common peritalar injuries to illustrate the nature of each and briefly describe methods for achieving the correct diagnosis in the context of acute trauma. This includes subtalar dislocations, chopart joint injuries, talar fractures, navicular fractures, and occult calcaneal fractures.

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Extra-articular Medial Impression Fracture of the Talus: A Previously Undescribed Injury

Foot & Ankle Specialist ◽

10.1177/1938640018788431 ◽

2018 ◽

Vol 11 (6) ◽

pp. 553-558

Author(s):

Olivier Wijers ◽

Rosa C. Looijen ◽

Jens A. Halm ◽

Tim Schepers

Keyword(s):

Correct Diagnosis ◽

Case Series ◽

Patient Characteristics ◽

Trauma Mechanism ◽

Retrospective Case ◽

Articular Fractures ◽

First Case ◽

Impression Fracture ◽

Talar Fractures ◽

Almost All

Background: Peripheral fractures of the talus are uncommon. Almost all the literature regarding talar fractures consists of central intra-articular fractures, whereas studies about peripheral talar fractures are lacking. The aim of this study is to increase awareness in diagnosing an unusual peripheral extra-articular medial impression fracture of the talus. Methods: This study includes a retrospective case series of patients with an extra-articular medial impression fracture of the talus. Patient characteristics, trauma mechanism, diagnostics, fracture characteristics, and treatment were reported. Results: Eight consecutive patients with an extra-articular medial impression fracture of the talus were identified. In 80%, the trauma mechanism was a supination or inversion injury of the ankle and foot. An X-ray was obtained in all patients; in 7 (88%) patients, a computed tomography scan was done, and an additional magnetic resonance imaging was done in 3 (38%) patients. In 4 patients (50%), the correct diagnosis was missed at first presentation. The delay between injury and diagnosis was 0 to 180 days (of 36 days on average). Conclusion: This is the first case series to describe patients with a peripheral extra-articular medial impression fracture of the talus. Good clinical examination and judicious use of diagnostic imaging are a necessity to find the talar impression fractures in a timely manner, and treatment can be started immediately. Levels of Evidence: Level V

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Calcaneal fractures cause a lateral load shift in Chopart joint contact stress and plantar pressure pattern in vitro

Journal of Biomechanics ◽

10.1016/0021-9290(96)84539-8 ◽

1996 ◽

Vol 29 (11) ◽

pp. 1435-1443 ◽

Cited By ~ 22

Author(s):

Dieter Rosenbaum ◽

Gerhard Bauer ◽

Peter Augat ◽

Lutz Claes

Keyword(s):

Contact Stress ◽

Plantar Pressure ◽

Lateral Load ◽

Calcaneal Fractures ◽

Pressure Pattern ◽

Chopart Joint ◽

Joint Contact

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Isolated “Nutcracker” Fracture of the Anterior Calcaneal Process: do we need a more Comprehensive Classification for this Inury Spectrum? A Case Report

10.33140/ijor.01.01.01 ◽

2018 ◽

Vol 1 (1) ◽

Keyword(s):

Plantar Flexion ◽

Correct Diagnosis ◽

Compression Fracture ◽

Low Energy ◽

Trauma Mechanism ◽

Calcaneal Fractures ◽

Avulsion Fractures ◽

X Ray ◽

Comprehensive Classification

Fractures of the anterior calcaneal process are relatively rare accounting for 3-15% of all calcaneal fractures and can occur due to high or low energy trauma. Avulsion fractures are generally due to forced inversion and plantar flexion of the foot and are associated with ligament tears. More are impaction fractures, i.e. nutcracker fractures, are commonly described as due to a forced eversion and abduction of the foot with compression forcing the anterior process of the calcaneus against the cuboid. Clinical features are subtle and X-ray examination for the diagnosis of anterior calcaneal process fracture is challenging. A CT examination can reveal the fracture and should be performed whenever a doubt exists for correct diagnosis. Here we present the unique clinical case of a 44ys old female patient who suffered an isolated compression fracture of the anterior calcaneal process due to a fall from a stair with forced foot eversion and low energy trauma mechanism. The patient healed uneventfully with a conservative treatment. A more comprehensive classification of this spectrum injury is sought as many different fracture or combined bone-ligamentous lesions exist requiring different surgical or non surgical management. Actually, no clear guidelines exist in literature assisting the treating physician in the management of such challenging lesions.

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Magnetic Resonance Myelography in Congenital Absence of the Cervical Pedicle

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2016.425 ◽

2017 ◽

Vol 44 (3) ◽

pp. 329-331 ◽

Cited By ~ 1

Author(s):

Rami Alhazmi ◽

Jean-Pierre Farmer ◽

Christine Saint-Martin

Keyword(s):

Correct Diagnosis ◽

Nerve Sheath Tumor ◽

Nerve Roots ◽

Acute Trauma ◽

Rare Congenital Anomaly ◽

Nerve Sheath ◽

Neoplastic Process ◽

Cervical Pedicle ◽

Additional Value ◽

Mr Myelography

AbstractAbsence of the cervical pedicle is a very rare congenital anomaly, easily misrecognized as a unilateral facet dislocation in a setting of acute trauma or a neoplastic process like a nerve sheath tumor. Although correct diagnosis can be achieved on the cervical radiograph and confirmed by the CT, MRI Myelography is clearly of additional value because shows the specific relationship and orientation of the nerve roots. To the best to our knowledge, this is the first description of MR Myelography findings.

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Combined Ipsilateral Fractures of Talus and Calcaneus

Foot & Ankle International ◽

10.3113/fai.2008.0318 ◽

2008 ◽

Vol 29 (3) ◽

pp. 318-324 ◽

Cited By ~ 7

Author(s):

Dominik Seybold ◽

Thomas A. Schildhauer ◽

Gert Muhr

Keyword(s):

Clinical Outcome ◽

Operative Treatment ◽

Perioperative Complications ◽

Fracture Pattern ◽

Surgical Approaches ◽

X Rays ◽

Calcaneal Fractures ◽

Intraarticular Fractures ◽

Foot Injury ◽

Talar Fractures

Introduction: The purpose of this study was to evaluate the frequency of combined ipsilateral talar and calcaneal fractures, the fracture pattern in combination and the clinical outcome of the combined operative treatment. Materials and Methods: Out of 950 patients with calcaneal fractures and 190 patients with talar fractures treated operatively between 1984 and 2003, 11 patients (1% of calcaneal and 6% of talar fractures) were identified with combined ipsilateral talar and calcaneal fractures. Closed reduction and external fixation was performed in one patient with a crush foot injury, and ORIF in all other patients and fractures. All patients underwent clinical and radiological evaluation after a minimum followup period of one year using the AOFAS-Hindfoot Score. Results: Seven patients had central talar body and 4 patients talar neck fractures. Nine calcaneal fractures were extraarticular sustentaculum, as well as processus anterior fractures, and two were intraarticular fractures. Average followup was 6 (range, 1 to 12.5; median, 4.5) years. There were no perioperative complications related to ORIF. AOFAS-Hindfoot-Score averaged 78.6 (range, 50 to 100). The followup x-rays showed post-traumatic arthritis in the ankle joint in 3 patients and in the subtalar joint in five. AVN with peudarthorsis was present in one patient with an intraarticular calcaneal fracture. Patients with intraarticular calcaneal fractures presented with the worst functional results (AOFAS-Score, 50 and 64), none of these patients required a secondary ankle or subtalar fusion. All other patients had good and excellent functional outcome. Conclusion: Combined ipsilateral talar and calcaneal fractures are rare injuries. Extraarticular calcaneal fractures are more common in this injury pattern, while there was no preference for either talar neck or talar body fractures. Operative treatment with anatomic open reduction and internal fixation may result in favorable clinical outcome. Combined surgical approaches to the hindfoot did not result in increased morbidity.

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Laryngeal Manifestations of Autoimmune Diseases

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2020_persp-19-00168 ◽

2020 ◽

Vol 5 (2) ◽

pp. 439-456

Author(s):

Jenny L. Pierce

Keyword(s):

Autoimmune Disease ◽

Autoimmune Diseases ◽

Patient Outcomes ◽

Correct Diagnosis ◽

Upper Airway ◽

Clinical Implications ◽

Laryngeal Function ◽

The Past ◽

Referral Practices ◽

Timely Referral

Purpose This review article provides an overview of autoimmune diseases and their effects on voice and laryngeal function. Method A literature review was conducted in PubMed. Combinations of the following keywords were used: “autoimmune disease and upper airway,” “larynx,” “cough,” “voice,” “dysphonia,” and “dyspnea.” Precedence was given to articles published in the past 10 years due to recent advances in this area and to review articles. Ultimately, 115 articles were included for review. Results Approximately 81 autoimmune diseases exist, with 18 of those highlighted in the literature as having laryngeal involvement. The general and laryngeal manifestations of these 18 are discussed in detail, in addition to the clinical implications for a laryngeal expert. Conclusions Voice, breathing, and cough symptoms may be an indication of underlying autoimmune disease. However, these symptoms are often similar to those in the general population. Appropriate differential diagnosis and timely referral practices maximize patient outcomes. Guidelines are provided to facilitate correct diagnosis when an autoimmune disease is suspected.

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